Vaccination coding crosses many specialties. See if you’ve got what it takes to code these common services. Answer the questions below based on the CPT® guidelines for vaccine immunization codes.
Take the Quiz
1. True or false: You may report vaccine immunization administration codes 90460, 90461, and 90471-90474 in addition to the vaccine and toxoid codes 90476-90749.
2. Which of the following codes is appropriate for IM vaccine administration not accompanied by face-to-face counseling by a physician (or other qualified health care professional) for a patient over 18 years of age?
- A. 90460
- B. 90461
- C. 90471
3. Documentation shows a significant separately identifiable 99213 service performed at the same encounter as the vaccine administration. Do CPT® guidelines allow you to report the E/M service in addition to the vaccine admin?
- A. Yes
- B. No
- C. The guidelines don’t specify
4. Code 90460 applies to the “first or only component of each vaccine or toxoid administered.” Which of the following is true?
- A. A component refers to all antigens in a vaccine that prevent disease(s) caused by any number of organisms.
- B. Multi-valent antigens against a single organism are considered a single component of vaccines.
- C. Adjuvants contained in vaccines are considered to be component parts of the vaccine.
Check Your Answers
1. The correct answer is True. You may report both an admin code and a vaccine/toxoid code for vaccinations. Keep in mind that Medicare requires G codes for administration. For instance, for pneumococcal vaccine admin, you should report G0009 (Administration of pneumococcal vaccine).
2. The correct answer is C for 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]). The answer isn’t obvious from the descriptor for 90471, but the guidelines support this choice, and both 90460 and +90461 have descriptors that begin with “Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional …”
3. The correct answer is A. The CPT® guidelines indicate you may report office and other outpatient services (99201-99215), consults (99241-99245), emergency department services (99281-99285), and preventive medicine services (99381-99429) in addition to the vaccine admin code. Keep in mind that payers may not follow CPT® guidelines. For example, Medicare CCI edits bundle established patient office visit code 99211 (sometimes called a nurse visit code) into codes like 90471.
4. The correct answer is B. The other two are not true. Answer A would be true if it stated “caused by one organism” instead of saying “caused by any number of organisms.” Option C would be true if it stated adjuvants “are not considered to be component parts.”
How About You?
Do you code for vaccinations? How do you keep up with the changing codes and different payer rules?